Healthcare Provider Details

I. General information

NPI: 1487338687
Provider Name (Legal Business Name): TASHA MARIE PYKKONEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST STE 505
TACOMA WA
98409-7208
US

IV. Provider business mailing address

6026 51ST STREET CT W
UNIVERSITY PLACE WA
98467-4121
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9909
  • Fax:
Mailing address:
  • Phone: 253-273-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: